Commentary: Early Clinical Indicators of Addison's Disease in Adults With Type 1 Diabetes: A Nationwide, Observational, Cohort Study
Abstract
We read with great interest the article by Chantzichristos et al. published in the Journal of Clinical Endocrinology and Metabolism. The paper presents the results of an observational, matched-cohort study which set out to determine whether there are any early clinical indicators for the onset of Addison's disease (AD) in adults with type 1 diabetes mellitus (T1DM).
In the first part of the study, the authors analyzed many variables within a period of 2 years before diagnosis of AD in 66 T1DM patients, using data from several registries. Comparisons were made with 330 controls, matched for age, sex, and duration of diabetes.
It was concluded that the presence of medical treatment for thyroid disease, a severe infection (expressed as necessity of hospital admission), and glucagon prescription for severe hypoglycemia should raise the suspicion of AD development in adults with T1DM. A significantly higher prevalence of diabetic retinopathy was also found in T1DM patients with AD.
The authors should be congratulated on their efforts to collect and analyse such a large amount of data and trying to correct for important covariables, leading to an interesting debate and highlighting this very important topic. Although we agree with many of the conclusions of this interesting and important study, we would like to make at least four comments